Recurrent Breast Cancer

Saturday, July 19, 2014

 Dupuytren's (du-pwe-TRANZ) contractures are a slow-process condition that lead to hand and finger deformity. It is due to cord-like tissue that forms under the palms. It may be present in both hands, though one hand is more affected the other.

Putting on gloves, shaking hands, and buttoning clothing can be challenging and painful.
It is more common in the right than the left.
The ring and small fingers are commonly affected, though the middle finger can be involved. Thumbs and index fingers are rarely affected. The cause of the problem isn’t known. It can occur with other conditions that cause contractures in other body parts, such as the feet.
Risk factors for this condition include:

Age. It occurs most commonly after age fifty.
Male gender. Men are more likely to develop Dupuytren's than women. Their contractures       are more severe compared to women.
The condition is prevalent in older men of Northern European descent.
Dupuytren's often runs in families.
Smoking may impair blood flow in the fingers, which worsens the condition. 
People with diabetes are reported to have an increased risk of Dupuytren's contracture.
A physician’s examination includes looking for skin puckering on the palms.
The condition can be diagnosed by a clinical exam in most cases.  Sophisticated testing and x-rays aren’t’ necessary.

Specific treatment may not be indicated. The condition progresses slowly, causes no pain, and has little impact on daily hand use. However, surgery may be helpful in severe cases.

Needling is a technique that involves insertion of a sterile needle through the skin to puncture and break the cord tissue that contracts the finger. Contractures can recur, but the procedure may be repeated. There is possible risk for nerve or tendon injury.

 Enzyme injections into the affected “palm cord” allows the surgeon to manipulate the patient’s hand and fingers. He injects an enzyme into the tight palm cord to soften and release the cord, which straighten the fingers.

 Surgery to release the tight hand tissue can slow the process and relieve symptoms. It provides a more complete joint release than injections. Post-operative occupational therapy is prescribed for several months.

Non operative techniques include finger stretching using the edge of a table, massage and heat, and avoidance of tight gripping for a few months.


Medical Blooper:  A husband and wife were in the waiting room when the nurse came out to see them.  "And what what seems to be the problem with you husband, Mrs. Johnson?" asked the nurse.  
"His problem," the woman answered "is that he is constantly worrying about money."
"Ah," said the nurse.  "I think the doctor can relieve him of that."

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